Spinal Cord Stimulation FAQs

F. Todd Wetzel, MD, answers frequently asked questions about spinal cord stimulators and neuromodulation.

The decision of whether spinal cord stimulation (SCS) is right for you is complicated. To help with this decision, SpineUniverse asked F. Todd Wetzel, MD, to answer frequently asked questions about spinal cord simulators and neuromodulation. Dr. Wetzel is President of the North American Spine Society and Professor of Orthopaedic and Neurological Surgery at Temple University School of Medicine in Philadelphia, PA.

Q: Will SCS make me pain free?
Dr. Wetzel:
Spinal cord stimulation is very effective for treating certain types of chronic pain related to nerve and tissue damage. While you might not have complete pain relief, a greater than 50% decrease in pain with SCS is considered successful. As one of the manufacturers has noted, think of it as a dimmer switch for  pain.

The best gauge of treatment success with SCS is a trial, where a temporary SCS is placed for a period of 5 to 10 days. The trial allows the patient to learn how to use the system, become familiar with the way it feels, and see what degree of comfort and pain relief it provides. The SCS trial is the best prognostic guide to how much pain relief will be provided with permanent SCS systems.
Illustration of the spinal cord highlighted within the human body.Q: Are all spinal cord stimulators the same?
Dr. Wetzel: Absolutely not. Over the last few years, a variety of different types of spinal cord stimulators have become available. The traditional stimulator is called tonic stimulation, where the patient feels a tingling sensation that some describe as a light massage in the area where they formerly felt pain.

Newer forms of SCS are called burst stimulation and high frequency stimulation, which provide pain relief in a different way. Burst stimulation shoots pulses of electrical activity to trigger certain pain-relieving neurons (cells in the nervous system). High frequency stimulation offers pain relief without a tingling sensation. The choice of spinal cord stimulation depends on type of chronic pain condition and patient preference.
 
Q: Can I have an MRI if I have a spinal cord stimulator?
Dr. Wetzel:
Most newer models of spinal cord stimulators are now MRI compatible, meaning that you can still have an MRI. Spinal cord stimulator models implanted a year or more ago may not be MRI compatible. In is important to talk to your doctor to see if your device is MRI compatible.

Q: After the device is implanted, do I need to take an antibiotic before dental cleaning or work?
Dr. Wetzel:
Yes, any time you have a foreign body implanted anywhere in your body, such as artificial heart valves, artificial joints, or spinal implants, you should take a dose of antibiotics before dental work. The reason for this precaution is because dental work occasionally causes bacteria to spill into the bloodstream, and if the bacteria reach the implant, they may continue to grow on the implant and create an infection.
 
Q: Is the SCS device surgically implanted in a hospital or outpatient setting? Should I see a spine surgeon or pain specialist to consult about SCS?
Dr. Wetzel: Most SCS trials—meaning a temporarily implanted SCS device—are performed in an outpatient setting. If your SCS trial is successful, you can have a permanent spinal cord stimulator implanted in an outpatient setting if a percutaneous lead is used. A percutaneous lead is a thin wire that delivers electrical impulses to the spinal cord.

In certain circumstances, a larger lead, which looks like a small paddle, is implanted on the spinal cord. The paddle lead requires a surgical technique called a laminotomy or laminectomy (removal of a small portion of bone in the spine) and is typically performed in an inpatient (hospital) setting.

Most SCS trials and implants are performed by pain specialists. Spine surgeons typically perform implants that require the larger paddle lead, because implantation requires an open surgery. In addition, many orthopedic surgeons and neurosurgeons with an interest in chronic pain can implant either a percutaneous or paddle lead. The key is to find an expert in your area who performs a high number of spinal cord stimulator implants every year.
 
Q: Can I continue to take certain over-the-counter and/or prescription medications with a spinal cord stimulator?
Dr. Wetzel: Absolutely. Many patients with spinal cord stimulators will require occasional medicines, particularly pain medications. For example, if SCS relieves approximately 80% of your pain on a regular basis, but you have a bit of breakthrough pain after a particularly active day, you may need to take pain medication. The need for pain medication after SCS implantation is based on the duration and severity of chronic pain and how much pain relief you experience with SCS.
 
Q: How do I learn how to use my spinal cord stimulator?
Dr. Wetzel: You are first taught how to use a spinal cord stimulator during the SCS trial. Your doctor or a programmer will meet with you in the recovery room to show you how to turn the device on and how to vary the strength of the stimulation. Later, once the device is implanted permanently you will be taught how to configure patterns of electrical stimulation so you can find which configuration is best for you. You also will be taught how to turn the stimulator off in case of an emergency, or if you want to take a break from stimulation.
 
Q:  How long will a spinal cord stimulator last?
Dr. Wetzel: Studies suggest that spinal cord stimulators may effectively relieve pain for up to 20 years. However, the battery in the neurostimulator has an expiration date. Most of these batteries are rechargeable, meaning that you can hold a charger over the neurostimulator that is implanted under the skin and recharge the battery when it is low. Currently, the battery life of these rechargeable devices is between 7 and 10 years. 
 
If the battery needs to be replaced, a physician will numb your skin, make a small incision in to remove the device, change the battery, and put the neurostimulator back in place. This is an outpatient procedure.

See our other articles about SCS:

Disclosures
Dr. Wetzel is on the Board of Trustees for McKenzie Institute International, is President of the North American Spine Society and has received stock options from Relevent Medsytems.

Updated on: 07/28/17
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